Alarming Increase of Ketoacidosis Prevalence at Type 1 Diabetes-Onset in Austria—Results From a Nationwide Registry

Abstract

ObjectiveWe analyzed the annual prevalence of onset-DKA (diabetic ketoacidosis) from 2012 to 2020 with a sub-analysis for lockdown-periods during the COVID-19 pandemic in 2020.DesignAll newly diagnosed children with type 1 diabetes (T1D) aged <15 years are prospectively registered in the population-based Austrian Diabetes Incidence Study in Austria.Main Outcome MeasuresThe annual DKA prevalence was analyzed using Joinpoint regression. Definition of DKA: pH <7.3, mild DKA: pH 7.3 to ≤ 7.1, severe DKA: pH <7.1. DKA prevalence during the lockdown periods in 2020 and the corresponding periods in 2015–2019 were examined using Fisher's exact test.ResultsIn the years 2012–2020 the mean prevalence for onset-DKA in Austria was 43.6% [95%CI (confidence interval): 41.6, 45.7] and thus above the mean prevalence of previous decades (1989–2011) of 37,1 % (95%CI: 35.6, 38.6). A particularly high prevalence was found among children <2 years of age (72.0% DKA, 32.8% severe DKA). No significant gender difference was found. Prevalence of severe DKA at T1D-onset increased significantly since 2015 (p = 0.023). During the lockdown in 2020, 59.3% of children were diagnosed with DKA at T1D-onset, compared to 42.1% during the previous 5 years (p = 0.022). Moreover, 20% of children had severe DKA at T1D diagnosis, compared to 14% during the comparison period.ConclusionsThe previously already high prevalence of DKA at T1D-onset has further increased over time. The COVID-19 pandemic has exacerbated the problem of a late or delayed diagnosis of diabetes in children resulting in onset-DKA. The alarmingly increased prevalence of DKA in Austrian children with T1D calls for urgent action.

Impact of the COVID-19 pandemic on long-term trends in the prevalence of diabetic ketoacidosis at diagnosis of paediatric type 1 diabetes: an international multicentre study based on data from 13 national diabetes registries

“… 10 , 11 An increased prevalence of diabetic ketoacidosis at diagnosis of type 1 diabetes was observed during the initial COVID-19 wave in diabetes centres in different parts of the world. 12 , 13 , 14 , 15 , 16 , 17 …”

Diabetes mellitus im Kindes- und Jugendalter (Update 2023)

“…In den letzten Jahren konnte in Österreich ein signifikanter Anstieg der DKA bei Erstmanifestation beobachtet werden. Die bedeutet, dass die Diagnose oft verzögert und sehr spät gestellt wird [ 3 , 4 ]. Die Erstmanifestation eines T1D kann in jedem Kindes- und Jugendalter auftreten, auch im Säuglingsalter, der Erkrankungsgipfel liegt im Volksschulalter, es sind aber zunehmend jüngere Kinder betroffen.…”

“…Eine weitere akute Komplikation ist die diabetische Ketoazidose (DKA). Wie bereits erwähnt, wurde in Österreich im Zeitraum 2012 bis 2020 ein deutlicher Anstieg der DKA bei Diabetesmanifestation beobachtet, wobei bei 44 % der Kinder und Jugendlichen im Rahmen der Diabetesmanifestation eine Ketoazidose (schwere DKA) festgestellt wurde [ 4 ]. Auch im Verlauf der Diabeteserkrankung ist eine DKA möglich, die Ursache ist immer Insulinmangel [ 27 ].…”

Delayed Management of Insulin-Dependent Diabetes Mellitus in Children

“…Diabetes is one of the most common chronic illnesses in pediatrics with an increasing incidence in recent years, exacerbated during the COVID-19 pandemic (Chao, Vidmar, & Georgia, 2021;Klingensmith et al, 2016;Lawrence et al, 2021;Nagl et al, 2022;Zylke & DeAngelis, 2007). An accurate and timely diagnosis is imperative to prevent acute complications such as diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS).…”